Comparison between thoracoscopic pleural cryobiopsy and conventional forceps biopsy in diagnosis of exudative pleural effusion: Assiut University experience

IF 0.2 Q4 RESPIRATORY SYSTEM Egyptian Journal of Chest Diseases and Tuberculosis Pub Date : 2023-01-01 DOI:10.4103/ecdt.ecdt_125_22
Reham M El-Morshedy, Maha M El-kholy, Nermeen A M H Kamel, Samiaa H Sadek, Alaa S Abdel Ghany, Marwan N Mohamed
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Abstract

Abstract Context Exudative pleural effusion is a diagnostic dilemma that includes many steps; one of them is obtaining a definite diagnosis through pleural biopsy. Cryoprobes are being increasingly used for obtaining larger specimens with fewer crush artifacts. However, the safety and feasibility of cryoprobe biopsy compared with standard forceps for pleural biopsy have not been fully assessed. Aims To evaluate the diagnostic value, size, and quality of the specimens obtained by flexible cryoprobe in comparison with those obtained by flexible forceps probe during medical thoracoscopy in patients with exudative pleural effusion and to assess the possible complications from the procedure. Settings and design This interventional prospective study was carried out at the endoscopy unit at Chest Department and Tuberculosis Assiut University Hospital. Patients and methods This study included 60 patients with undiagnosed exudative pleural effusion. Medical thoracoscopy was carried out for all the patients, and pleural biopsies were taken from the parietal pleura using a conventional rigid forceps probe and flexible cryoprobe in the same settings. Results Cryoprobe biopsy established a definite diagnosis in 55/60, with 91.6% diagnostic yield, whereas forceps biopsy had a definite diagnosis in 53/60, with 88.3% diagnostic yield. The size of cryoprobe biopsy was significantly larger in comparison with the forceps biopsy (26.56 ± 22.16 vs. 17.38 ± 12.08 mm 2 ; P <0.001). The depth of pleural biopsy was evaluated by the presence of extrapleural fat cells, which were significantly higher in cryoprobe biopsy in comparison with forceps biopsy [21 (35%) vs. 11 (18.3%); P =0.03]. There were no significant complications or procedure-related deaths. Conclusions Cryobiopsy is a possible safe and effective alternative to conventional forceps probe biopsy in the diagnosis of exudative pleural effusion with a larger, deeper, and less number of biopsies. It was also found that cryoprobe biopsy had a better diagnostic yield, sensitivity, and accuracy.
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胸腔镜胸膜冷冻活检与常规产钳活检诊断渗出性胸腔积液的比较:Assiut大学的经验
摘要背景渗出性胸腔积液是一个诊断难题,包括许多步骤;其中之一是通过胸膜活检得到明确的诊断。冷冻探针越来越多地用于获得更大的标本,更少的挤压伪影。然而,冷冻探针活检与标准钳进行胸膜活检的安全性和可行性尚未得到充分评估。目的比较医用胸腔镜下柔性冷冻探头与柔性钳探头对胸腔渗出性积液的诊断价值、标本的大小和质量,并对其可能出现的并发症进行评价。背景和设计本介入前瞻性研究在阿西尤特大学医院胸科内窥镜科进行。患者与方法本研究纳入60例未确诊的渗出性胸腔积液患者。所有患者均接受内科胸腔镜检查,并在相同环境下使用常规刚性钳探针和柔性冷冻探针从胸膜壁层进行胸膜活检。结果冷冻活检确诊率为55/60,诊断率为91.6%;钳活检确诊率为53/60,诊断率为88.3%。冷冻探针活检组织的大小明显大于钳活检组织(26.56±22.16 vs. 17.38±12.08 mm 2;P & lt; 0.001)。通过胸膜外脂肪细胞的存在来评估胸膜活检的深度,与钳活检相比,冷冻探针活检的胸膜外脂肪细胞明显更高[21(35%)比11 (18.3%);P = 0.03)。无明显并发症或手术相关死亡。结论低温活检在诊断渗出性胸腔积液中具有较大、较深、较少活检次数的优点,可替代传统的钳探针活检,是一种安全有效的方法。我们还发现冷冻活检具有更好的诊断率、敏感性和准确性。
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来源期刊
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发文量
46
审稿时长
22 weeks
期刊介绍: The journal will cover technical and clinical studies related to health, ethical and social issues in field of The Egyptian Journal of Chest Diseases and Tuberculosis aims to publish and inform readers and all chest physicians of the progress in medical research concerning all aspect of chest diseases. Publications include original articles review articles, editorials, case studies and reports which are relevant to chest diseases. The Journal also aims to highlight recent updates in chest medicine. . Articles with clinical interest and implications will be given preference.
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